{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T04:27:05Z","timestamp":1791174425281,"version":"4.1.0"},"reference-count":41,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2023,5,15]],"date-time":"2023-05-15T00:00:00Z","timestamp":1684108800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background. The most important anthracycline side effect is cardiotoxicity, resulting in congestive heart failure (HF). Early detection of cardiac dysfunction and appropriate treatment can improve outcomes and reduce the progression of HF. The aim of our study was to evaluate changes in clinical data, echocardiographic parameters, and NT-proBNP, as well as their associations with early anthracycline-induced cardiotoxicity (AIC) in patients treated with anthracycline-based chemotherapy. Methods and Materials. Patients with breast cancer were prospectively assessed with echocardiography, as well as NT-proBNP testing at baseline, (T0), after two cycles (T1) and four cycles (T2) of chemotherapy. AIC was defined as a new decrease in the LVEF of 10 percentage points, to a value below the lower limit of normal. Results. We evaluated 85 patients aged 54.5 \u00b1 9.3 years. After a cumulative dose of 237.9 mg\/m2 of doxorubicin, 22 patients (25.9%) met the criteria of AIC after chemotherapy. Patients who subsequently progressed to cardiotoxicity had demonstrated a significantly larger impairment in LV systolic function compared to those who did not develop cardiotoxicity (LVEF: 54.0 \u00b1 1.6% vs. 57.1 \u00b1 1.4% at T1, p &lt; 0.001, and 49.9 \u00b1 2.1% vs. 55.8 \u00b1 1.6% at T2, p &lt; 0.001; GLS: \u221217.8 \u00b1 0.4% vs. \u221219.3 \u00b1 0.9% at T1, p &lt; 0.001, and \u221216.5 \u00b1 11.1% vs. \u221218.5 \u00b1 0.9% at T2, p &lt; 0.001, respectively). The levels of NT-proBNP increased significantly from 94.8 \u00b1 43.8 ng\/L to 154.1 \u00b1 75.6 ng\/L, p &lt; 0.001. A relative decrease in GLS \u2264 \u221218.0% (sensitivity: 72.73%; specificity: 92.06%; AUC, 0.94; p &lt; 0.001) and a relative increase in NT-proBNP &gt; 125 ng\/L (sensitivity: 90.0%; specificity: 56.9%; AUC, 0.78; p &lt; 0.001) from baseline to T1 predicted subsequent LV cardiotoxicity at T2. Conclusions. Decrease in GLS and elevation in NT-proBNP were significantly associated with AIC, and these could potentially be used to predict subsequent declines in LVEF with anthracycline-based chemotherapy.<\/jats:p>","DOI":"10.3390\/medicina59050953","type":"journal-article","created":{"date-parts":[[2023,5,16]],"date-time":"2023-05-16T02:37:51Z","timestamp":1684204671000},"page":"953","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Prognostic Impact of Global Longitudinal Strain and NT-proBNP on Early Development of Cardiotoxicity in Breast Cancer Patients Treated with Anthracycline-Based Chemotherapy"],"prefix":"10.3390","volume":"59","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9892-7688","authenticated-orcid":false,"given":"Gintare","family":"Muckiene","sequence":"first","affiliation":[{"name":"Cardiology Clinic, Medical Academy, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania"},{"name":"Department of Cardiology, Hospital of Lithuanian University of Health Sciences, 50161 Kaunas, Lithuania"},{"name":"Kaunas Region Society of Cardiology, 44307 Kaunas, Lithuania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Domas","family":"Vaitiekus","sequence":"additional","affiliation":[{"name":"Department of Oncology and Hematology, Hospital of Lithuanian University of Health Sciences, 50161 Kaunas, Lithuania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8797-999X","authenticated-orcid":false,"given":"Diana","family":"Zaliaduonyte","sequence":"additional","affiliation":[{"name":"Cardiology Clinic, Medical Academy, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania"},{"name":"Department of Cardiology, Hospital of Lithuanian University of Health Sciences, 50161 Kaunas, Lithuania"},{"name":"Kaunas Region Society of Cardiology, 44307 Kaunas, Lithuania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vytautas","family":"Zabiela","sequence":"additional","affiliation":[{"name":"Cardiology Clinic, Medical Academy, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania"},{"name":"Department of Cardiology, Hospital of Lithuanian University of Health Sciences, 50161 Kaunas, Lithuania"},{"name":"Kaunas Region Society of Cardiology, 44307 Kaunas, Lithuania"},{"name":"Institute of Cardiology, Lithuanian University of Health Sciences, 50161 Kaunas, Lithuania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raimonda","family":"Verseckaite-Costa","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Hospital of Lithuanian University of Health Sciences, 50161 Kaunas, Lithuania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dovile","family":"Vaiciuliene","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Hospital of Lithuanian University of Health Sciences, 50161 Kaunas, Lithuania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6695-7786","authenticated-orcid":false,"given":"Elona","family":"Juozaityte","sequence":"additional","affiliation":[{"name":"Institute of Oncology, Lithuanian University of Health Sciences, 50161 Kaunas, Lithuania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Renaldas","family":"Jurkevicius","sequence":"additional","affiliation":[{"name":"Cardiology Clinic, Medical Academy, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania"},{"name":"Department of Cardiology, Hospital of Lithuanian University of Health Sciences, 50161 Kaunas, Lithuania"},{"name":"Kaunas Region Society of Cardiology, 44307 Kaunas, Lithuania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,5,15]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"E359","DOI":"10.1002\/ijc.29210","article-title":"Cancer incidence and mortality worldwide: Sources, methods and major patterns in GLOBOCAN 2012","volume":"136","author":"Ferlay","year":"2015","journal-title":"Int. J. Cancer"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1287","DOI":"10.1016\/j.mayocp.2014.05.013","article-title":"Evaluation and management of patients with heart disease and cancer: Cardio-oncology","volume":"89","author":"Herrmann","year":"2014","journal-title":"Mayo Clin. Proc."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1213","DOI":"10.1016\/j.yjmcc.2012.03.006","article-title":"Doxorubicin-induced cardiomyopathy: From molecular mechanisms to therapeutic strategies","volume":"52","author":"Octavia","year":"2012","journal-title":"J. Mol. Cell. Cardiol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1093\/jnci\/djp440","article-title":"Cardiotoxicity of anticancer drugs: The need for cardio-oncology and cardio-oncological prevention","volume":"102","author":"Lbini","year":"2010","journal-title":"J. Natl. Cancer Inst."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"333","DOI":"10.1002\/1097-0142(1967)20:3<333::AID-CNCR2820200302>3.0.CO;2-K","article-title":"Daunomycin, an antitumor antibiotic, in the treatment of neoplastic disease. Clinical evaluation with special reference to childhood leukemia","volume":"20","author":"Tan","year":"1967","journal-title":"Cancer"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"911","DOI":"10.1016\/j.echo.2014.07.012","article-title":"Expert consensus for multimodality imaging evaluation of adult patients during and after cancer therapy: A report from the American Society of Echocardiography and the European Association of Cardiovascular Imaging","volume":"27","author":"Plana","year":"2014","journal-title":"J. Am. Soc. Echocardiogr."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"2768","DOI":"10.1093\/eurheartj\/ehw211","article-title":"ESC Scientific Document Group. 2016 ESC Position Paper on cancer treatments and cardiovascular toxicity developed under the auspices of the ESC Committee for Practice Guidelines: The Task Force for cancer treatments and cardiovascular toxicity of the European Society of Cardiology (ESC)","volume":"37","author":"Zamorano","year":"2016","journal-title":"Eur. Heart J."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"816","DOI":"10.1093\/annonc\/mdn728","article-title":"Expert opinion on the use of anthracyclines in patients with advanced breast cancer at cardiac risk","volume":"20","author":"Dixon","year":"2009","journal-title":"Ann. Oncol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"194","DOI":"10.1016\/j.ijcard.2009.09.564","article-title":"Cardiotoxicity after anthracycline chemotherapy in breast carcinoma: Effects on left ventricular ejection fraction, troponin I and brain natriuretic peptide","volume":"148","author":"Feola","year":"2011","journal-title":"Int. J. Cardiol."},{"key":"ref_10","first-page":"e596","article-title":"2019 ACC\/AHA Guideline on the Primary Prevention of Cardiovascular Disease: A Report of the American College of Cardiology\/American Heart Association Task Force on Clinical Practice Guidelines","volume":"140","author":"Arnett","year":"2019","journal-title":"Circulation"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1093\/ehjci\/jev014","article-title":"Recommendations for cardiac chamber quantification by echocardiography in adults: An update from the american society of echocardiography and the european association of cardiovascular imaging","volume":"16","author":"Lang","year":"2015","journal-title":"Eur. Heart J. Cardiovasc. Imaging"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1016\/j.jcmg.2007.12.007","article-title":"Myocardial strain measurement with 2-dimensional speckle-tracking echocardiography: Definition of normal range","volume":"2","author":"Marwick","year":"2009","journal-title":"JACC Cardiovasc. Imaging"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1428","DOI":"10.1183\/09031936.00150314","article-title":"An official European Respiratory Society\/American Thoracic Society technical standard: Field walking tests in chronic respiratory disease","volume":"44","author":"Holland","year":"2014","journal-title":"Eur. Respir. J."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"710","DOI":"10.7326\/0003-4819-91-5-710","article-title":"Risk factors for doxorubicin-induced congestive heart failure","volume":"91","author":"Layard","year":"1979","journal-title":"Ann. Intern. Med."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"66","DOI":"10.15420\/cfr.2016:24:2","article-title":"Cancer and Heart Failure: Understanding the Intersection","volume":"3","author":"Hamo","year":"2017","journal-title":"Card. Fail. Rev."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1016\/j.ijcha.2015.11.004","article-title":"Doxorubicin induced heart failure: Phenotype and molecular mechanisms","volume":"10","author":"Mitry","year":"2015","journal-title":"IJC Hear. Vasc."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"47266","DOI":"10.1074\/jbc.M106829200","article-title":"Doxorubicin-induced apoptosis is associated with increased transcription of endothelial nitric-oxide synthase: Effect of antiapoptotic antioxidants and calcium","volume":"276","author":"Kalivendi","year":"2001","journal-title":"J. Biol. Chem."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"154","DOI":"10.1016\/S1734-1140(09)70018-0","article-title":"Anthracycline-induced cardiotoxicity: Overview of studies examining the roles of oxidative stress and free cellular iron","volume":"61","author":"Simunek","year":"2009","journal-title":"Pharmacol. Rep."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"7685","DOI":"10.1200\/JCO.2005.08.789","article-title":"Cardiotoxicity of cancer therapy","volume":"23","author":"Floyd","year":"2005","journal-title":"J. Clin. Oncol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"440","DOI":"10.1097\/FPC.0b013e32833ffb56","article-title":"Doxorubicin pathways: Pharmacodynamics and adverse effects","volume":"21","author":"Thorn","year":"2011","journal-title":"Pharmacogenet. Genom."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"819","DOI":"10.1093\/annonc\/mdf167","article-title":"Frequency and risk factors of subclinical cardiotoxicity after anthracycline therapy in children: A systematic review","volume":"13","author":"Kremer","year":"2002","journal-title":"Ann. Oncol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1738","DOI":"10.1056\/NEJM199506293322602","article-title":"Female sex and drug dose as risk factors for late cardiotoxic effects of doxorubicin therapy for childhood cancer","volume":"332","author":"Lipshultz","year":"1995","journal-title":"New Engl. J. Med."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"683","DOI":"10.1111\/bcp.13008","article-title":"Recommendations for genetic testing to reduce the incidence of anthracycline-induced cardiotoxicity","volume":"82","author":"Aminkeng","year":"2016","journal-title":"Br. J. Clin. Pharmacol."},{"key":"ref_24","first-page":"227","article-title":"Anthracycline cardiotoxicity after breast cancer treatment","volume":"23","author":"Hershman","year":"2009","journal-title":"Oncology"},{"key":"ref_25","first-page":"865","article-title":"Anthracycline cardiomyopathy monitored by morphologic changes","volume":"62","author":"Billingham","year":"1978","journal-title":"Cancer Treat. Rep."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1673","DOI":"10.1136\/heartjnl-2014-305538","article-title":"Prognostic implications of global LV dysfunction: A systematic review and meta-analysis of global longitudinal strain and ejection fraction","volume":"100","author":"Kalam","year":"2014","journal-title":"Heart"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"vii155","DOI":"10.1093\/annonc\/mds293","article-title":"Cardiovascular toxicity induced by chemotherapy, targeted agents and radiotherapy: ESMO Clinical Practice Guidelines","volume":"23","author":"Curigliano","year":"2012","journal-title":"Ann. Oncol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"493","DOI":"10.1016\/j.echo.2013.02.008","article-title":"Independent and incremental value of deformation indices for prediction of trastuzumab-induced cardiotoxicity","volume":"26","author":"Negishi","year":"2013","journal-title":"J. Am. Soc. Echocardiogr."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1375","DOI":"10.1016\/j.amjcard.2011.01.006","article-title":"Early detection and prediction of cardiotoxicity in chemotherapy-treated patients","volume":"107","author":"Sawaya","year":"2011","journal-title":"Am. J. Cardiol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"222","DOI":"10.1002\/jcu.22434","article-title":"Speckle tracking echocardiography predicts early subclinical anthracycline cardiotoxicity in patients with breast cancer","volume":"45","author":"Tang","year":"2016","journal-title":"J. Clin. Ultrasound"},{"key":"ref_31","first-page":"392","article-title":"Assessment of global longitudinal strain at low-dose anthracycline-based chemotherapy, for the prediction of subsequent cardiotoxicity","volume":"18","author":"Charbonnel","year":"2017","journal-title":"Eur. Hear. J. Cardiovasc. Imaging"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"215","DOI":"10.1097\/MCP.0b013e3283455cda","article-title":"Utilization of B-type natriuretic peptide and NT-proBNP in the diagnosis of pleural effusions due to heart failure","volume":"17","author":"Porcel","year":"2011","journal-title":"Curr. Opin. Pulm. Med."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"151","DOI":"10.3349\/ymj.2010.51.2.151","article-title":"Interpretation and use of natriuretic peptides in non-congestive heart failure settings","volume":"51","author":"Tsai","year":"2010","journal-title":"Yonsei Med J."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"715","DOI":"10.1016\/j.leukres.2011.01.018","article-title":"NT-proBNP: A cardiac biomarker to assess prognosis in non-Hodgkin lymphoma","volume":"35","author":"Gimeno","year":"2011","journal-title":"Leuk. Res."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"318","DOI":"10.1007\/s00392-007-0633-6","article-title":"Usefulness of myocardial performance index and biochemical markers for early detection of anthracycline-induced cardiotoxicity in adults","volume":"97","author":"Dodos","year":"2008","journal-title":"Clin. Res. Cardiol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"285","DOI":"10.1016\/j.ijcard.2017.02.109","article-title":"Reliability, construct validity and determinants of 6-minute walk test performance in patients with chronic heart failure","volume":"240","author":"Mesquita","year":"2017","journal-title":"Int. J. Cardiol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"e1810","DOI":"10.1002\/pri.1810","article-title":"Validity and reliability of the 6-min step test in individuals with coronary artery disease","volume":"25","author":"Travensolo","year":"2019","journal-title":"Physiother. Res. Int."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"631","DOI":"10.1055\/s-0032-1323746","article-title":"Validity of the six-minute walk test in cancer patients","volume":"34","author":"Schmidt","year":"2013","journal-title":"Int. J. Sport Med."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"R33","DOI":"10.1530\/ERP-17-0013","article-title":"Cardio-oncology: What you need to know now for clinical practice and echocardiography","volume":"4","author":"Larsen","year":"2017","journal-title":"Echo Res Pract."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"791","DOI":"10.1517\/14740338.5.6.791","article-title":"Anthracycline cardiotoxicity","volume":"5","author":"Jones","year":"2006","journal-title":"Expert Opin. Drug Saf."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1007\/s11936-014-0315-4","article-title":"Anthracycline-induced cardiotoxicity: A review of pathophysiology, diagnosis, and treatment","volume":"16","author":"Raj","year":"2014","journal-title":"Curr. Treat. Options Cardiovasc. Med."}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/59\/5\/953\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T19:35:36Z","timestamp":1760124936000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/59\/5\/953"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,5,15]]},"references-count":41,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2023,5]]}},"alternative-id":["medicina59050953"],"URL":"https:\/\/doi.org\/10.3390\/medicina59050953","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,5,15]]}}}